Management overview for clozapine poisoning

Clozapine is an antipsychotic drug that is not widely used and deliberate self-poisoning is rare because prescribing is restricted. Therapeutic doses of clozapine can cause agranulocytosis and myocarditis (see here for more detail), but acute ingestions are not associated with these effects.

Scenarios where clozapine poisoning can occur include:

• treatment-naive patients starting the drug or escalating the dosage
• elderly patients in aged-care facilities who receive the drug mistakenly or an incorrect dose
• patients who are nonadherent or have had their treatment temporarily interrupted, who are restarted on an inappropriately high dose.

The main effects of clozapine poisoning are similar to other antipsychotic drugs and most patients have a benign course. Management of clozapine poisoning is primarily supportive care.